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General NPI Number Information
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NPI Number | 1639614837
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Entity Type | Organization
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Legal Business Name | NORTHEAST DENTAL SURGERY CENTER PC
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 1073 OAK ST B STE
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City | PITTSTON
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State | PA
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Zip | 18640-3716
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Country | US
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Telephone | 570-237-1838
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 OAK ST B STE
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City | PITTSTON
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State | PA
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Zip | 18640-3716
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Country | US
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Telephone | 570-237-1838
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MR. SHAWN M CASEY
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Credential | DMD
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Telephone | 570-237-1838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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